DONNA JACKSON'S ARTWORK ORDER FORM
| DAYDREAMS: | Quantity:____ @ $55.00 ea. + $6.50 shipping and handling per print. Sub-total: $________ |
| FRIENDS: | Quantity:____ @ $35.00 ea. + $5.50 shipping and handling per print. Sub-total: $________ |
| PARTNERS: | Quantity:____ @ $35.00 ea. + $5.50 shipping and handling per print. Sub-total: $________ |
| PA. RESIDENTS AD 6% SALES TAX: $________ | |
| (Tax on $55.00 = $3.30) (Tax on $35.00 = $2.20) | |
| Total: $________ |
| NAME: | ___________________________________________________________ |
| ADDRESS: | ___________________________________________________________ |
| CITY: | ___________________________________________________________ |
| STATE/PROVINCE: | ___________________________________________________________ |
| ZIP/POSTALCODE: | ___________________________________________________________ |
| COUNTRY: | ___________________________________________________________ |
| PHONE: | ___________________________________________________________ |
| E-MAIL: | ___________________________________________________________ |